2017 group JAAOS 2020 Flashcards
The failure rate of DAIR in infected TKR with virulent organisms (MRSA, VRE) approaches 80%
True
JAAOS March 2020
Extension of antibiotic duration in DAIR of infected TKR increases rate of cure
False
Does not increase rate of cure, only postpones failures
JAAOS March 2020
Systemic absorption of high dose abx from cements spacers in infected TKR persists for at least 8 weeks
True
JAAOS March 2020
There are few indications for spacer exchange in treatment of infected TKR
False
Indications: Wound healing problems Infection persists Mechanical failure of spacer Sinus drainage
JAAOS March 2020
Possible complications of cement spacers in TKR infection include mechanical instability and nephrotoxicity
True
JAAOS March 2020
The standard posterior viewing portal in shoulder arthroscopy is generally 5-6cm proximal to quadrangular space
False
It is 3-5 cm away, so axillary nerve is in danger
JAAOS March 2020
In iatrogenic nerve laceration following shoulder surgery, primary end-end repair should be performed within 7-10 days
False
Ideally within 72 hours. This is due to possible proximal end of nerve retraction (especially after 7 days), which will require interposition graft for repair and has worse outcomes
JAAOS March 2020
The portal of Neviaser places the axillary nerve at risk
False
Suprascapular nerve is at risk. The Navieser portal is the one between clavicle and acromion
JAAOS March 2020
Nerve injuries due to regional anaesthesia in shoulder surgery have a 99% rate of resolution at 1 year
True
JAAOS March 2020
Shoulder arthroscopy in lateral position has a reported rate of 10-30% of nerve traction injury
True
JAAOS March 2020
Beach chair positioning for shoulder surgery is associated with injuries to the greater auricular nerve and lesser occipital nerve
True
From head positioning
JAAOS March 2020
Early mobilization after rotator cuff repair (before 8 weeks) improves Patient Reported Outcome measures and Functional outcomes at 6 months.
False
No difference between early and late (>8 weeks) mobiliazation
JAAOS March 2020
High BMI and Diabetes are independant risk factors for poor Patient Reported Outcome measures after rotator cuff repair
False
BMI = no difference in PROs, but higher retear rate
Diabetes is indeed associated with poor outcomes
JAAOS March 2020
STT arthritis is associated with DISI deformity and type 2 lunate
True
JAAOS March 2020
STT arthrodesis has good fusion rate
False
Has a 4-30% non-union rate
JAAOS March 2020
STT OA is easily identified on preop xrays
False
Pre-op sensitivity is <50%, intraop inspection is mandatory
JAAOS March 2020
STT OA in 64% of patients with basilar thumb OA
True
JAAOS March 2020
If distal scaphoid excision is being performed for STT OA, at least 3mm should be resected
False
Yes, a distal scaphoid excision is an option, but excising more than 3mm increases the rate of DISI
JAAOS March 2020
Tandem stenosis occurs in approximately 1% of patients with symptomatic lumbar stenosis
False
10%
JAAOS March 2020
Congenital canal stenosis predisposes to tandem stenosis
True
JAAOS March 2020
Torg pavlov ratio of 0.78 in lumbar spine is also predictive of cervical myelopathy
True
JAAOS March 2020
In cervical & lumbar tandem stenosis, decompression of cervical spine may alleviate symptoms attributed to lumbar spine pathology also
True
JAAOS March 2020
A timed up and go test is a simple and useful adjunct to assess physical conditioning and muscle strength
True
JAAOS March 2020
Clindamycin is safer and equally effective in preventing infection in shoulder arthroplasty as compared to Vancomycin
False
Higher infection rate with Clindamycin. Same infection rate with Cephazolin and Vanco. Use Vanco if Penicillin allergy.
JAAOS March 2020 - Retrospective study
Rate of radial nerve palsy with humeral shaft fracture is 12%
True
Range 7-17%
JAAOS March 2020
Radial nerve palsies occur more commonly in comminuted fractures of the humerus
False
More common in distal third fractures, transvers or spiral, open fractures.
JAAOS March 2020
There is a better rate of recovery of secondary/ iatrogenic injuries compared to primary injuries
True
Only 1% of radial nerves were found to be incarcerated in humerus fracture at time of surgical exploration
False
10%
JAAOS March 2020
77% of patients get recovery of radial nerve palsy with expectant management
True
However, 89% recovery with early (<3 weeks) exploration.
JAAOS March 2020
Deep wound infection rate in nonidiopathic scoliosis (syndromic, congenital or neuromuscular) correction is around 20%
True
5% to 40%
JAAOS Feb 2020
The Spinalis dorsi, Latissimus dorsi and Iliocostalis make up the Erector Spinae group of muscles
False.
Spinalis dorsi, Longissimus dorsi and iliocostalis.
JAAOS Feb 2020
The Latissimus dorsi muscle is supplied by the thoracodorsal artery
True.
Thoracodorsal artery and nerve.
JAAOS Feb 2020
The Saline Load Test is more sensitive and specific than clinical judgement in the evaluation of traumatic arthrotomies
True.
JAAOS Feb 2020
CT scan has poor reliability as compared to Saline Load Test in the evaluation of traumatic arthrotomies
False.
CT has 100% SN and SP
JAAOS Feb 2020
The addition of Methylene blue increases the sensitivity and specificity of the Saline Load Test to nearly 100% in the evaluation of traumatic arthrotomies
False
Makes no difference
JAAOS Feb 2020
Post-operative “suction – irrigation” can decrease the need for re-operation and the rate of septic arthritis in the management of traumatic arthrotomies
False
Ineffective and increases infection
JAAOS Feb 2020
Obtaining cultures of traumatic knee arthrotomies is unreliable and unnecessary
True
JAAOS Feb 2020
Despite modern surgical techniques and antibiotics, the rate of septic arthritis in traumatic arthrotomies remains similar to the World War 1 era.
False
100% in WW1 to 0% in modern.
JAAOS Feb 2020
The first cervical sclerotome (proatlas) forms the apex of the dens, the posterior superior arch of the atlas, and the apical, alar, and cruciate ligaments
False.
The 4th OCCIPITAL sclerotome is the proatlas.
JAAOS Feb 2020
Anomalies of the odontoid process are more common in patients with congenital syndromes such as trisomy 21, Klippel-Feil malformation, and skeletal dysplasias
True.
JAAOS Feb 2020
Spinal cord MRI signal changes in the setting of an os odontoideum are an absolute indication for surgical fusion.
True.
JAAOS Feb 2020
The vertebral artery is at higher risk with C1 lateral mass screw placement than C1-C2 transarticular screw placement.
False.
C1 lateral mass screw – dorsal venous plexus = bleeding. C1-C2 transarticular screw = Vertebral artery
JAAOS Feb 2020
Venous serum lactate and troponin remain normal in Acute Compartment Syndrome
False.
They are both elevated and may assist in the diagnosis of ACS.
JAAOS Feb 2020
A perfusion pressure (Diastolic – Compartment) of greater than 30 mmHg is safe to rule out Acute Compartment Syndrome.
True.
JAAOS Feb 2020
Dual incision Fasciotomy is superior to single incision fasciotomy in the management of Acute Compartment Syndrome.
False.
No evidence to say one is better than the other.
JAAOS Feb 2020
Negative pressure wound therapy delays the time to final wound closure and increases the need for skin grafting in the surgical management of Acute Compartment Syndrome.
False.
Decreases time to wound closure and reduces the need for skin grafting.
JAAOS Feb 2020
Surgical Fasciotomy is contra-indicated in cases of Acute Compartment Syndrome with Irreversible Ischaemia
True.
JAAOS Feb 2020
Female gender, primiparity, family history and breech presentation are known risk factors for Developmental Dysplasia of the Hip.
True
JAAOS Feb 2020
The Lateral Center-Edge Angle (LCEA) of Wiberg for normal hips is in the range between 0 to 20 degrees.
False.
25-39 = normal,
less than 20 = DDH,
more than 40 = protrusio.
JAAOS Feb 2020
The Sourcil angle of Tonnis is less than 10 degrees for normal hips.
True.
> 10 degrees = dysplasia
JAAOS Feb 2020
The Anterior Center-Edge Angle (ACEA) of Lequesne as seen on the false-profile view of normal hips is in the range of 25 to 40 degrees.
True.
The ACEA measures anterior coverage of the femoral head. Values <20 are indicative of dysplasia, values >40 are indicative of FAI.
JAAOS Feb 2020
The “cross-over” sign on an AP x-ray of the hip has low sensitivity, but high specificity for excess acetabular anteversion.
False.
It is associated with acetabular retroversion. But is not very specific.
JAAOS Feb 2020
Gadolinium has been shown to become permanently deposited in brain tissues in patients without renal failure.
True.
However, the long-term effects of these deposits is unclear.
JAAOS Feb 2020
Acetabular dysplasia in adults leads to increased articular contact stresses and femoral head subluxation.
True
JAAOS Feb 2020
Labral hypertrophy is a common finding in adults with acetabular dysplasia and femoral head uncoverage.
True.
JAAOS Feb 2020
Burnese Peri-Acetabular Osteotomy is an accepted treatment option in Adult Dysplasia of the Hip prior to the onset of arthritis.
True.
This is allegedly the most common acetabular sided osteotomy for adult DDH.
JAAOS Feb 2020
Pelvic osteotomy for Adult DDH has a survivorship of 74% at 10 years and 52% at 20 years.
False.
88% at 10,
61% at 20,
29% at 30 (from one study),
92% at 15 and
74% at 18 (in more modern studies).
JAAOS Feb 2020
Patients who have Total Hip Arthroplasty after previous Peri-Acetabular Osteotomy have higher rates of complications and revisions and lower Harris Hip Scores as compared to patient with no previous acetabular osteotomy.
False.
No difference.
JAAOS Feb 2020
Morphologic differences of the proximal femur in adult patients with Hip Dysplasia include femoral neck shortening, wide femoral canal and femoral neck retroversion.
False.
Short neck, Anteversion, Narrow canal, Straight canal, Head aspericity.
JAAOS Feb 2020
Preoperative opioid use is associated with higher morbidity and mortality following elective orthopaedic procedures?
True
JAAOS Apr 2020
The CB1 cannabinoid receptor is found primarily in the peripheral nervous system?
False
Found primarily in the CNS on the neurons and glia cells of the brain and has a high affinity for THC
JAAOS Apr 2020
Studies have shown that smoked cannabis is effective for neuropathic pain in patients with HIV?
True
JAAOS Apr 2020
Chronic marijuana users have the same risk of lung cancer as tobacco smokers?
False
? increased risk ?
JAAOS Apr 2020
Cannabis use has been associated with decreased mortality in patients undergoing major joint arthroplasty and femur fracture fixation
True
But higher risk of medical complications.
JAAOS Apr 2020
Overlengthening the lateral humeral offset by as little as 5 mm can decrease range of motion and cause abnormal translation and increased subacromial contact?
True
JAAOS Apr 2020
Stemless humeral implants are contraindicated in humeral head AVN?
False
relative indications are middle age with advanced arthritis, AVN or if a revision is expected within the patients lifetime
JAAOS Apr 2020
A lesser tuberosity osteotomy is contraindicated due to risk of metaphyseal disruption
False
LT osteotomy may be performed, it just needs to be thin. Authors recommend ~2mm thick
JAAOS Apr 2020
A commonly used method of determining lateral humeral offset is the distance from the base of the coracoid to the lateral aspect of the greater tuberosity
True
JAAOS Apr 2020
Current evidence suggests superior clinical and radiographic outcomes of stemless implants compared to stemmed
False
no evidence of superiority. Equivalence at best in short to mid term studies
JAAOS Apr 2020
Studies in the hip and knee arthroplasty literature have demonstrated a strong correlation between preoperative functional scores and clinical outcomes
True
JAAOS Apr 2020
patients of low socioeconomic status undergoing shoulder arthroplasty have worse pre-operative function
True
JAAOS Apr 2020
patients of low socioeconomic status undergoing shoulder arthroplasty have worse pre-operative pain
True
JAAOS Apr 2020
patients of low socioeconomic status undergoing shoulder arthroplasty have lower rate of opioid use
False
JAAOS Apr 2020
patients of low socioeconomic status undergoing shoulder arthroplasty have a higher rate of diabetes mellitis
True
JAAOS Apr 2020
Elderly patients should be counselled that, compared to younger patients, they have an increased risk of mortality and increased risk of revision in Total Hip Arthroplasty.
False
Lower risk of revision
JAAOS Apr 2020
There is a moderate recommendation against the use of glucosamine sulfate in hip arthritis
True
Does not improve symptoms
JAAOS Apr 2020
There is a limited recommendation that general anaesthetic may have benefits over neuraxial anaesthesia in Total Hip Arthroplasty
False
Some evidence that Neuraxial may reduce complications
JAAOS Apr 2020
The AAOS guidelines do not recommend one surgical approach over others in Total Hip Arthroplasty
True
JAAOS Apr 2020
There is strong evidence against the use of intraarticular hyaluronic acid in Hip Arthritis
True
Does not improve symptoms
JAAOS Apr 2020
Trauma is responsible for up to 39% of osteomyelitis
False
19%
JAAOS Apr 2020
Penicillins and cephalosporins are bacterocidal
True
JAAOS Apr 2020
Routine wound cultures are recommended at the time of initial treatment of open fractures
False
No evidence to support this
JAAOS Apr 2020
There is no evidence of benefit for the continued administration of antibiotics beyond 24 hours after closure or definitive coverage of open fractures
True
JAAOS Apr 2020
Fluoroquinolones should be considered in patients with type III open fractures and pre-existing kidney disease
True
The standard (aminoglycosides) are nephrotoxic
JAAOS Apr 2020
Topical vancomycin powder may reduce the risk of surgical site infection in fixation of high risk open fractures
True
JAAOS Apr 2020
Empiric antibiotic treatment for open fractures with severe tissue damage lasts for 7 days
True
JAAOS Apr 2020
The force necessary for knee extension is directly dependent on the perpendicular distance between the patellar tendon and the knee flexion axis
True
JAAOS Apr 2020
In patella baja, the patella is always in contact with the trochlea in extension
True
This is in contrast to a normal patella
JAAOS Apr 2020
Congenital patella baja has three distinguishing characteristics: (1) distal positioning of the patella in the femoral trochlea, (2) shortening of the length of the patellar tendon, and (3) increased distance between the distal pole of the patella and the articular surface of the proximal tibia
False
Decreased distance betwen the distal pole and proximal tibia
JAAOS Apr 2020
Retention of the infrapatellar fat pad may decrease the incidence of patella baja in total knee arthroplasty
True
JAAOS Apr 2020
In true patella baja, both modified Insall-Salvati ratio and Blackburne-Peel ratio will be abnormally low. In pseudopatella baja, Insall-Salvati ratio will be normal, however, Blackburne-Peel ratio will be low
True
In pseudopatella baja there is no shortening of the patellar tendon
JAAOS Apr 2020
The upper extremity is the site of almost 30% of all soft-tissue sarcomas
True
JAAOS Apr 2020
Tumors of the scapula account for about 50% of primary bone cancers originating in the shoulder
False
20% scapula
JAAOS Apr 2020
Functional results with the use of upper limb endoprosthesis for oncologic and non-oncologic indications are comparable
True
JAAOS Apr 2020
Many series show excellent mid to long-term results for pain relief and function after resection and reconstruction with an upper limb endoprosthesis
True
JAAOS Apr 2020
Resection of the axillary nerve is an absolute contraindication to endoprosthetic reconstruction
False
JAAOS Apr 2020
Regarding the acetabular origin of the ligamentum teres; the most robust is the posterior band, which originates at the ischial end of the TAL
True
JAAOS Apr 2020
The artery to the ligamentum teres (LT) most commonly arises from a branch of the lateral femoral circumflex artery
False
Obturator artery usually
JAAOS Apr 2020
In running and jumping, forces of up to 10 times body weight may pass through the hip
True
JAAOS Apr 2020
the squat position, the important lateral iliofemoral ligament is tight
False
It is lax. This is where the ligamentum teres may be an important stabilizing structure
JAAOS Apr 2020
During reconstruction, the anteroinferior quadrant of the acetabulum should be utilised for graft placement
False
Antero-inferior is “zone of death”
PosteroSuperior or PosteroInferior is where to place graft
JAAOS Apr 2020
Optimizing modifiable patient risk factors significantly reduces the risk of Periprosthetic Joint Infection
False
The evidence is unclear and this includes obesity.
JAAOS Apr 2020.
Intra-articular injection prior to total joint arthroplasty may have a time-dependent association for increased risk of Periprosthetic Joint Infection
True
But this is based on Limited evidence
JAAOS Apr 2020
The use of antibiotic cement in preventing Periprosthetic Joint Infection is supported in the literature for both hip and knee arthroplasty
False
Not supported for knee replacements
JAAOS Apr 2020
Sonication of suspected Periprosthetic Joint Infection is not recommended due to a high false positive rate
False
JAAOS Apr 2020
The use of gram stain to rule out Periprosthetic Joint Infection is not recommended
True
A negative gram stain does not rule out infection
JAAOS Apr 2020
The use of serum CRP, ESR and IL-6 are strongly recommended by the AAOS in the diagnosis of Periprosthetic Joint Infection.
True
JAAOS Apr 2020
